I dream of teeth

On Wednesday night I dreamed I went to see my dentist and she wasn't there. Many strange events and circumstances had transpired to make me late, and when I arrived her area was empty. I was very sad, because this meant that I was never going to have my stitches removed and would have a mass of wet string in my mouth for the rest of my life. (Is it weird that I'm now dreaming about going to the dentist? Let's hope it was just because I really wanted my stitches out!)

Thankfully, this did not happen when I went in on Friday. I was a few minutes late thanks to the mass transit system being what it is, but it wasn't a problem. However, once Fatema had called me from the waiting room and brought me back to her chair she discovered that Dr. Chueng was nowhere to be found. Dr. Chueng is the one who has been taking the measurements in my mouth from the start, so we couldn't possibly take them without her.

Fatema called and left her a message and set about completing the portion of the appointment that she could do on her own--taking photographs of my progress and removing the stitches. She applied a topical numbing agent, so I couldn't feel much while she was cutting the thread and pulling it out, but I could see the pieces of thread as they came out, and it's amazing how long some of them were.

By the time we had finished that, Dr. Chueng had appeared and we were able to take the measurements. Afterward Fatema gave me a fancy new interdental brush to keep the spaces between my teeth clean. I won't be allowed to floss for many more weeks as the bone and soft tissue continue to grow, but the plaque still needs to be kept out. The same company also makes extra-soft toothbrushes which are better for my extra sensitive tissue post-surgery. Sadly, the only store in all of Massachusetts that sells them is about two hours away by car. Who would have thought I would end up buying my toothbrushes online? Still, it's a small price to pay for a healthy mouth. That's what I have to keep telling myself when I get frustrated by the pain and inconvenience of oral surgery. The pain is temporary, but the benefits are long-lasting. I may not be able to bite into an apple right now, but I'll be glad when I am an old woman and able to do so with my own teeth.

-Kim

Surgery 2

I have eaten about 10 gallons of ice cream in the last week. At least, that's what it seems like. Last Friday I had the second surgery of this long process to reinforce my mouth. Last fall was the lower right quadrant, and this time we did the lower left.

The surgery went as planned--4 hours in the dentist chair having my gums cut open and stitched back together. I won't bother you with the grisly details this time (you can check out the post from last time for that). Now that the periodontal department is on the 12th floor, the surgical room has a much better view. The chair was parallel to the window rather than facing it, but as I was looking toward the ceiling for the whole four hours, it hardly matters. There were fewer students watching the procedure this time, but the (rather good-looking) head resident did pop in toward the end when Dr. Griffin was stitching me up.

I got to listen to my iPod this time, which was a lovely distraction. The playlist started out with Jeremy Camp, the artist I always go to when what I really want is for someone to hold my hand.

The incision was larger this time, reaching past the center of the mouth to expose the bone added last time so the new graft could join it properly. Once he had exposed the graft he commented on how amazed he was at the three dimensional growth. Fatema took a picture of the comparison between the exposed root of the new site and the new, thicker bone of the previous site. It was a perfect before and after picture and could even end up in a published article someday. That would be pretty awesome.

Over the weekend my diet consisted almost entirely of ice cream, and I slept most of the day in a nest of cushions I built to keep my head elevated. Apparently it did the trick, because when I went for my one week check-up yesterday Fatema was amazed at how quickly my healing was progressing. The swelling is going down much more quickly than before, and the pain is fading as well. When the pain does flare up, usually just when it's time that I can take more pain meds, it doesn't stretch across the whole site, but centers itself around the pointed eye tooth, right in the corner. I realize that my mouth is actually round and doesn't have a corner, but mentally that's what it feels like.

I can eat any soft foods now, but ice cream is still a large part of my menu, since it requires little to no chewing and can therefore be eaten more quickly than anything more substantial or with actual nutrients. Eating is a difficult task now--it requires both hands and careful attention as I must choose only soft foods and cut everything into pieces rather than bite directly in. It takes longer than it should, and I can't do anything else. For instance, I had to stop twice while writing this post to eat some Ben & Jerry's Key Lime Pie ice cream. Oral surgery would be a great diet, except that it leaves me feeling hungry all the time, and the easiest things to eat are terribly unhealthy.

Still, it's good to know I'm making such good progress and will be back to myself again soon. And more importantly, it's good to know the first procedure was so successful, and that this whole painful process really is worthwhile.

-Kim

mouth update

So, it's been a while since I told you guys what's been going on in my mouth. My last visit to my dentist for this year was the Friday before Thanksgiving. They took another set of measurements to note the change in height and thickness of my gum tissue and took a couple more pictures. One month after surgery, even with the swelling gone, there was a noticeable difference. Even I can tell the difference just by looking and comparing the right side to the left. And it will continue to improve. I have been instructed to return to brushing my teeth, using only gentle, upward strokes on the surgery side, to massage the tissue farther upward. At my three-month appointment in January they'll take final measurements and pictures before moving on to the next quadrant. We're going to do the lower left next and get the worth part of the process over with before the start of spring semester. Fatema assured me that it will have been long enough since the first surgery to allow for doing the lower again, which is a relief. Given the choice, I'd rather have the slightly easier upper surgeries later in the semester when I'll need to recover more quickly. Besides, doing the lower left in January means the swelling should be gone by the time COF orchestra rehearsals begin for spring. Since that is the side the violin rests on, this is a very important detail.

Of course, when I go back next it will be a whole new experience. The afternoon of my last appointment the new periodontal floor on the 14 floor of the building had its grand opening. It's actually the 13 floor, but the Tufts dental tower is one of those buildings that refuses to acknowledge that it has a 13 floor. I expect the clinic to be shiny and new still when I get there. I hope it's not too bright though. I have found, in my weekly visits to the clinic for cleanings and measurements that going to the dentist can actually be quite relaxing. At least, on this last visit I was in very real danger of falling asleep in the dental chair while Fatema and Dr. Chen bustled back and forth getting ready to take the measurements. I mean, it's a familiar place, my dentists are very sweet people who have always remembered to numb me when they do anything that might hurt, and they leave me there reclining in a chair that, while not as cosy as a bed, has just enough cushion to do the trick. It may also have had something to do with the general sense of exhaustion that had built up over the week, but I still say it's a sign of how good they've been to me. Or it could just be that I'm weird. Either way, I'm still very glad that I don't have to go back there again until the end of January. I'm almost eating like a normal person again--still doing the chewing on the left (except when I forget), but I've moved up to actually biting into my food instead of cutting up pizza with a knife and fork. Hooray for normalcy!

-Kim

Periodontal Quest: Surgery 1

*Warning: this post contains slightly graphic descriptions of surgery. Do not read while eating.*

Well, the day finally came. After weeks of taking impressions and radiographs (x-rays) and making and changing appointments, my first periodontal bone-grafting surgery is finally behind me. It was quite the experience.

I received a phone call from my dentist Fatema on Thursday afternoon asking if I could come in earlier on Friday (10:00am) to take a couple more impressions and one last radiograph. Apparently all the work we did last time wasn't good enough. That's terribly frustrating, since making the impressions last time was such a pain. This time it actually went much more smoothly. Two on top and two on the bottom, all came out well and we were done. Amazing. Why couldn't that have happened at the last appointment? Having deep enough trays really makes a difference. And before that we did the radiograph. We had already taken shots of my entire mouth piece by piece, but this was a 360 degree scan. I had this done before, when my braces were taken off, and I think when I had my wisdom teeth out. I love how quickly it goes--just stand still and watch a machine circle around my head.

After the impressions they asked me to wait in the lobby while they prepared a stint to take a few measurements. But that took too long, so eventually Fatema came out and said I should just go get lunch. She led me through the complex to a cafeteria where Tufts students eat, so I had my last normal meal surrounded by future dentists.

The surgery took place in a small room just off the large room where all the cubicle-style dental chairs are. There was a large window to my right, and an inspirational poster about teamwork with a picture of a sailboat on the wall in front of me. Before anything else, Fatema took my blood pressure and had me take extra-strength pain relievers. It was an electronic blood pressure cuff that went around my wrist--very high tech and impressive. Not surprisingly, my pulse was a bit fast, since I was nervous at the beginning of this whole process. Then they had to draw some blood, to mix with the bone powder to make the graft material. I don't remember whether I've had blood drawn before, but I was surprised how little it hurt. They actually tried twice on my right arm and finally got the four vials they needed from my left, so now my multiple holes make me look like a drug user. But on the bright side, they only used two of the vials, so they probably won't have to draw any blood for the next surgery.

There were a lot of people in the room throughout this process. It took 3 dentists to draw my blood, plus a couple others running around making sure we had all the supplies we needed. Colette was very nice and talked to me to keep me calm while I waited between steps. Next came the measurements. We had to recheck the depth of recession, plus take a whole new set of measurements using plastic stints molded from the impressions taken earlier. They measured the thickness of my gum tissue by measuring how many millimeters away from the plastic stint it was, and then comparing that to the distance to the bone once it was uncovered.

But now I'm getting ahead of myself.

They didn't give me anything to make me loopy, so I was aware of what was going on the whole time. I was, however, completely numbed and couldn't feel a thing. Fatema and Michael, the assisting dental student, were impressed by the fact that I didn't even flinch when they injected the anesthetic. Once I was all numbed, we only had to wait for Dr. Griffen to arrive to conduct the surgery. Dr. Griffen wears glasses, so I was able to watch the entire process in the reflection.

Have you seen the advertisements for the show House MD, or any other medical drama? They always have a picture of the cast peering down over the camera as if they were examining a patient. Well, now I know what that feels like. I had Dr. Griffen doing the surgery, Fatema and Michael assisting, and 2-3 other dental students observing. They were also filming the procedure and taking photographs throughout.

The first step was to cut my gum tissue away from the teeth and bone. Dr. Griffen gave a lecture on his favorite tool and how to use it as he worked, cutting and peeling the very thin tissue. Once the flap was cut away, Fatema used a scaling tool to clean the plaque and remaining fragments of tissue off the bone so that the bone graft would be able to stick effectively. They also put the plastic stint back on and took new measurements. While this was going on, one of the other students was mixing my centirfuged blood platelets with bone powder to create the grafting material. Dr. Griffen used a tweezer shaped implement to put this gelatinous material into the areas where my bone had receded. Over this they placed a membrane that looked remarkably like tissue paper. This membrane had to be stitched together to keep the bone graft stable, along with another layer of a material I can't spell. The thread used was rather yellowish. The thread used next to hold the gum tissue back in place over the graft was purplish.

This description reads far too quickly. The whole process took from 1:00pm until after 5:00pm. Between the stages I had to be reminded to relax my jaw, I got so used to holding it open. But by the end I could barely hold still for the stitches, I had been lying there so long.

The surgery reminded me of book binding and manuscript repair, oddly enough. The membrane used to cover the bone graft looked like the Japanese paper used to repair torn manuscripts, and the skin flaps were stitched together much the same way the text block of a book is created. These are the thoughts that ran through my mind as I watched Dr. Griffen put these foreign materials in my mouth to strengthen my tissue. Not being able to feel what was being done, I had a disconnected interest in the reflection, imagining it was someone else's mouth being cut into and messed around with. At least until the end. As Dr. Griffen was putting in the very last stitch I started to get some feeling back. It didn't so much hurt, but the feeling of thread moving through my gum tissue was bizarre to say the least. They gave me another shot before tying it off.

Christina came to meet me at the clinic and brought me home on the T by way of a CVS to get my prescriptions filled. My orders were to keep ice on it and eat only cold, soft foods. This meant, of course, that my dinner consisted entirely of ice cream. That was the best part of the whole experience.

I was still partly numb when I finally went to bed, and the pain meds they gave me have been keeping things under control. It's hard to eat--I mostly have to drink my nutrition, though I can chew on the left side. I expected there to be more pain, but thus far I only have a very dull ache when I near the 8 hour interval between doses of the meds they gave me. Perhaps I just have a high pain tolerance, or it could just be that I heal quickly. Tierney has decided to call me Wolverine, because of the bone grafting. It's beginning to seem more appropriate, and the experience is giving me story ideas. At least something will come out of the experience.

-Kim

the periodontal quest

I have virtually perfect teeth. I brush twice a day and floss every night. I had braces, and I've had my wisdom teeth out, but overall dental health seemed to be in the bag.

My gums had other plans.

Apparently my bone and gum tissue is thinner than average and predisposed to recession. My dentist at home had me coming in for frequent cleanings to combat the recession, but it came to the point that he finally told me to find a gum specialist, a periodontist.

There's no better place to find a medical professional than Boston. And for reasonably priced care, I was directed to Tufts Dental School. All the students there seem to be from foreign countries, and instead of having separate offices, they all have their dental chairs and equipment set up in little cubicles in a large room. At the beginning of August I met my dentist, Fatema. She is from Kuwait, but lived for six years in Dublin. And she shocked me with x-rays of my front teeth, which showed dramatic bone recession between my lower front teeth. She thinks it was likely my braces that pushed the teeth out of their sockets and accelerated the recession. Not cool. Apparently I also have unusual roots on my two front teeth--short and kind of heart shaped.

The decision was that I need to have surgery. The supervising dentist (who has a stutter, but knows teeth and gums) suggested I would be a good candidate for a treatment so new I might be able to get it for free. It involves mixing my blood platelets with bone powder and putting it where my own bone has receded.

Cool, huh?

Technically, I'm getting the treatment for free (though still paying for the materials used) because I'm participating in a study. The downside of that is every step of the process has to be documented.

Today I spent three hours in the dentist chair getting my teeth photographed and having impressions taken. It's quite an effective form of torture. The only way to properly photograph a tooth would be to take it out of the mouth, but since that's not an option, we settle for stretching the lips past what I though was their limit to keep them out of the shot. The worst part is that while my dentist was holding the camera and another dentist was jamming a mirror in my mouth, I was holding the implements that did the actual stretching. And taking the impressions was worse. They needed two sets of impressions, so I knew going in I would have trays of pink goo in my mouth at least four times. In the end it was quite a few more: four to get the top and four for the bottom. It was tough because the mold had to record the receded gums as well as the teeth. The last one almost gagged me, and even thinking of the Virgin Islands like the dentist from the cubicle next door suggested didn't help.

The theory is that all of this effort and discomfort will be worth it when my perfectly healthy teeth don't fall out of my mouth on my 30th birthday. The surgeries will be spread out over the next several months as we tackle my mouth in quadrants. The first one is in just a few weeks, so be ready for another installment in this saga of periodontal proportions.

-Kim